with Paulina Firozi

Nearly 9 in 10 rural counties in the United States now have at least one covid-19 patient.

Rural areas of the country, where 15 percent of Americans live, are seeing a rise in new daily cases even as the numbers decline in New York City and other urban centers that are now past their peak, according to Carrie Henning-Smith, a rural health researcher at the University of Minnesota School of Public Health. These new hot spots aren’t seeing the declines experts had hoped for, even after weeks of social distancing.

The shift is occurring even as state governors — both Democrats and Republicans — plan to restart economic activities in phases through the month of May, faced with unemployment claims so hefty some states are now seeking loans from the federal government to pay them. While many states haven’t met the qualifications for reopening laid out by the White House, President Trump is nonetheless cheerleading them in choosing to reopen.

Former FDA commissioner Scott Gottlieb:

Total covid-19 cases are still much lower in rural areas compared to cities. But they’re already growing at faster rates.

In the two-week period between April 13 and 27,  novel coronavirus cases increased 125 percent in non-metro counties, compared to 68 percent in metro counties, according to research by the Kaiser Family Foundation. During that time period, deaths from the virus increased 169 percent in non-metro counties and 113 percent in metro counties.

The county with the most deaths per capita is Randolph County, Ga., with 278 deaths per 100,000 people (our colleagues have written deep-dive pieces about the area and how it has been ravaged by the disease).

It's not entirely clear why cases aren't being tamped down more quickly. It could be that people haven't socially distanced enough. The virus also took longer to spread to rural areas, so these places have been expected to peak later than the big cities.

“I think a lot of people are doing social distancing, taking this very seriously, but people still need to go out for work or running errands,” said Henning-Smith. “Eventually you can get a case in there and it starts to spread.”

Rural Americans lag behind urban and suburban dwellers on nearly every measure of health and wellness.

They tend to be older, earn lower incomes, have higher rates of unemployment and struggle with more chronic health conditions than the average person. 

They live farther away from hospitals. Those rural hospitals typically have fewer ventilators, ICU beds and overall staff than urban hospitals. In the past decade, 128 rural hospitals have shuttered — three since the pandemic began. Half of all rural hospitals operate in the red.

One might think urban residents would be at higher risk from covid-19, because they’re around dense crowds and public transportation more often.

But the pattern of flu deaths shows the risk of death is dramatically higher in the country’s thinly populated regions.

Centers for Disease Control and Prevention records indicate very rural areas have a 60 percent higher death rate from the flu than big metro areas, my colleagues Dan Keating and Laris Karklis reported in March.

“Collectively, the 68 most rural counties of Kansas, for instance, have nearly 14 deaths per 100,000 people age 50 or older, well over double the rate for the county around Topeka (6.6), the state capital,” they wrote. “And the rate around New York City (3.4) is around half of that.”

There are unique challenges for rural people in marginalized communities. About one-third of Navajo Nation residents lack indoor plumbing, making it hard to carry out even the most basic preventive measure of hand-washing.

Volunteers there are creating public hand-washing stations by repurposing detergent bottles as makeshift faucets, Frances Stead Sellers reports.

“Infection and death rates have ramped up in rural areas, particularly in the Deep South and other regions plagued by poverty,” she writes. “The Navajo Nation, for example, ranks close behind hot spots in the Northeast for infection rates.”

“Nobody is thinking about these pockets of vulnerability,” said George McGraw, founder and chief executive of the nonprofit DigDeep, who noted a “strong correlation” between the spread of the virus and communities that lack water.

Ahh, oof and ouch

AHH: The White House is looking to disband its coronavirus task force. 

Trump said the task force will likely shutter and be replaced with “something in a different form.” 

“I think we’re looking at phase two and we’re looking at other phases. The country is starting to open up; the task force has done a phenomenal job,” Trump said while touring a Honeywell mask factory in Phoenix. 

Vice President Pence told reporters the group tasked with managing the government’s response to the pandemic would wind down its work within a month because of “the tremendous progress we’ve made as a country.”

“I think we’re starting to look at the Memorial Day window, early June window as a time when we could begin to transition back to having our agencies begin to manage — begin to manage our national response in a more traditional manner,” he said.

“Despite the continuing pace of deaths and new infections from the virus across the country, Pence said the White House believes that great progress has been made,” Seung Min Kim and Josh Dawsey report in The Post’s live blog. “Before Pence’s comments, task force members had been told to expect fewer meetings and an eventual disbanding of the group, but they have were given no specific date, said one person with direct knowledge of the discussions who spoke on the condition of anonymity to describe the private conversations.”

Already, the task force has stopped meeting daily. 

One person involved in the effort told The Post it was “disheartening but clear” senior officials in the administration, Trump included, are “ready to move on.” 

OOF: Ousted vaccine official Rick Bright says he was demoted for prioritizing “science and safety.”

Bright, former director of the Biomedical Advanced Research and Development Authority, was removed from his post late last month and reassigned to a narrower role at the National Institutes of Health. 

In a whistleblower complaint, Bright says the move was made because he sought to “prioritize science and safety over political expediency” and raised health concerns over a drug repeatedly touted by Trump as a possible coronavirus cure, Yasmeen Abutaleb and Laurie McGinley report. 

“Bright portrays himself in the 89-page complaint as an administration health official trying to sound the alarm about the virus beginning in early January,” they write. “He said he called for the rapid development of treatments and vaccines, as well as the stockpiling of additional N95 face masks and ventilators, at a time when HHS political leadership, including Secretary Alex Azar, appeared to him to be underestimating the threat.”

“Government leadership was rushing blindly into a potentially dangerous situation by bringing in non-FDA approved chloroquine from India and Pakistan from facilities that had not been inspected by the FDA,” Bright told reporters. “I could not in good conscience ignore the scientific recommendations to limit access to those drugs under the direct care of a doctor, and instead allow political ambition and timelines to override scientific judgment.”

In a statement, HHS spokeswoman Caitlin Oakley said Bright was “transferred to NIH to work on diagnostics testing — critical to combating covid-19 — where he has been entrusted to spend upwards of $1 billion to advance that effort. We are deeply disappointed that he has not shown up to work on behalf of the American people and lead on this critical endeavor.”

OUCH: Fifteen children in New York City have developed a potentially serious inflammatory condition that could be linked to covid-19. 

The children experienced a condition similar to a syndrome known as Kawasaki disease. More than half had a rash, abdominal pain, vomiting or diarrhea. Fewer than half had respiratory issues. None of these children have died, Ariana Eunjung Cha and Chelsea Janes report.

Health authorities in New York warned of the unusual condition in an alert that was similar to what Britain’s national authority issued late last month, noting an “apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions.”

“Craig Sable, associate division chief of cardiology at Children’s National Hospital in the District, said that many of the children with similar illnesses described by European colleagues have recovered, but that it’s unclear whether they will suffer any longer-term consequences,” Ariana and Chelsea write. ‘

The coronavirus response

The coronavirus working group led by Jared Kushner struggled to procure urgent medical supplies because its private-sector volunteers lacked needed experience, a former volunteer alleges.

The volunteer — who filed a complaint with the House Oversight Committee that was obtained by The Post — says the team had little success in helping the government secure personal protective equipment, partly because none of its members had significant experience in health care, procurement or supply-chain operations, Yasmeen Abutaleb and Ashley Parker report.

“In addition, none of the volunteers had existing relationships with manufacturers or a clear understanding of customs requirements or Food and Drug Administration rules, according to the complaint and two senior administration officials,” they write, adding that six administration officials and one outside adviser to the effort confirmed key elements of the complaint.

Furthermore, “even as the volunteer group struggled to procure PPE, about 30 percent of ‘key supplies,’ including masks, in the national stockpile of emergency medical equipment went toward standing up a separate Kushner-led effort to establish drive-through testing sites nationwide,” Yasmeen and Ashley write. “Kushner had originally promised thousands of testing sites, but only 78 materialized; the stockpile was used to supply 44 of those over five to 10 days, the document said.”

The New York Times added that VIP tips by media personalities and Trump allies were prioritized: “In one case, Jeanine Pirro, the Trump stalwart and Fox host, repeatedly contacted task force members and FEMA officials until 100,000 masks were sent to a hospital she favored.”

Democrats in Congress and liberal activists have also gone after Kushner's team, calling it a “shadow task force” with private-sector actors. 

But the private-sector volunteers accounted for just 10 percent of all people working on the effort, two team leaders told Politico's Dan Diamond.

The leaders “said the volunteers’ work largely focused on analysis and sourcing calls,” Dan writes. “The team instead was mostly staffed by officials at FEMA, HHS and the White House … as well as dozens of federal contractors.”

Since April 1, the team has been working to identify total lab testing capacity by speaking with dozens of companies involved in the supply chain, Dan writes. By the week of April 13, the team had briefed Trump aides that the federal government could acquire enough supplies to ensure 8 million tests could be conducted in the United States in May.

Pfizer has started testing a coronavirus vaccine in people. 

The pharmaceutical giant began testing multiple versions of an experimental vaccine in healthy young people — five people were administered doses on Monday. 

One person will get a placebo, while the other four will receive the experimental vaccination, Carolyn Y. Johnson reports. The vaccine is being developed with the German company BioNTech. 

It’s the “first step toward establishing the safety, dosage and most promising candidate to take into larger trials that will test effectiveness,” she writes. “In an unusual trial design that signals the pressing need to find a vaccine against covid-19, Pfizer is initially testing four versions of the vaccine, side by side. Typically, companies spend years on animal experiments and select a single promising candidate to put into human testing, but the drugmaker decided to create a flexible trial that could rapidly sift out the best option.”

Kathrin Jansen, Pfizer’s head of vaccine research and development, said the target is to have a vaccine ready for high-risk groups by the fall. That goal is ambitious and mirrors the timeline from a University of Oxford group also working on a vaccine. “There are at least eight other vaccine candidates being tested in people worldwide, according to a tracker by the Milken Institute,” Carolyn adds. 

Here are a few more good stories and developments to catch up on this morning: 

Congress on the coronavirus: 
  • Trump’s demand for a payroll tax cut for workers has little support, even among Republicans in Congress. It’s the latest hurdle as lawmakers try to move forward with the next phase of coronavirus relief, Seung Min, Mike DeBonis and Erica Werner report.
The Trump administration’s response: 
  • Trump wouldn’t commit to taking a coronavirus vaccine if one becomes available, saying he would do “whatever is best for the country,” Felicia Sonmez reports.
  • Trump didn’t wear a mask – though he did don goggles –  during his tour of the Honeywell mask production facility in Phoenix. “A sign was posted in the part of the facility Trump toured reading, ‘Face Mask required in this Area.’ A separate sign at the entrance of the Honeywell facility read, ‘Please wear your mask at all times,’” Felicia writes. “According to a White House official, the Honeywell facility said officials were not required to wear masks.”
The hardest hit: 
  • Legal advocates at Georgetown University Law Center filed a lawsuit on behalf of millions of children who are U.S. citizens and have been denied coronavirus relief payments because one or both of their parents are undocumented, Spencer S. Hsu reports.
  • Pastor Mike Carrion leads the evangelical Promised Land Covenant Church in the poorest congressional district in the nation. In the span of a month, 13 parishioners experienced the deaths of close family members and a best friend, Sarah Pulliam Bailey reports. “No seminary class prepares you for this,” Carrion said.
There’s still more to learn about the coronavirus: 
  • A not yet peer-reviewed research paper from scientists at Los Alamos National Laboratory reports one strain of the novel coronavirus has emerged in Europe, which could mean the virus has mutated. But the hypothesis was met with skepticism by many infectious-disease experts, Sarah Kaplan and Joel Achenbach report.
Around the world: 
  • Coronavirus cases in Asia hit 250,000 yesterday, Reuters’s Jane Wardell reports, noting it has taken the continent four months to reach that infection milestone. “The region where the COVID-19 pandemic started has fared better overall than North America and Europe since the first case was reported in Wuhan, China on Jan. 10,” Jane writes.
Good to know: 
  • Face masks have evolved into the latest way people are expressing themselves. There are masks for “every taste and budget,” Robin Givhan reports. “Fashion always finds a way,” she writes.

Sugar rush